This Angel is pissed off. I'm Nurse Anne and I work on large general medical ward in the NHS. These are the wards with the most issues surrounding nursing care. The problems are mostly down to intentional understaffing by hospital chiefs that result in a lack of real nurses on the wards.
"The martyr sacrifices themselves entirely in vain. Or rather not in vain, for they merely make the selfish more selfish, the lazy more lazy and the narrow more narrow"-Florence Nightengale

Monday, 8 February 2010

What is going on? What happened to respect?

No one has any respect for real nurses and junior doctors.

How I miss our experienced Health care assistants. Now we get apprentices as they are called. They are thrown onto the ward with no training and no experience in the place of experienced staff.

They wander around in nurse's uniforms and refuse to answer bells and help with turns. They are unable to do observations. "That is all the nurse's job" they say. Well yes everything is actually the nurse's job, but I have a 150 drugs due in the next 45 minutes, the consultants are here to do their rounds, and family members are queing up to lay into me. My blood transfusion is here and I need to do 10 things to get it started, and monitor the patient.

Consultants are constantly yelling at the nurses for observation charts not being done and intake and output charts not getting filled in. They know damn well that it is physically impossible for the lone Nurse to attend to all of those things. But they yell anyway. I have no choice but to rely on the apprentices. But I don't know how to get them to understand the importance of recording how much fluid a patient is drinking and how much they are voiding...without that information we could send someone into pulmonary oedema or miss pre-renal failure. Just keeping those charts accurate for all those people would be a full time job on it's own. They just refuse to do it an I can't be there to do it for all those people. The apprentices know that the consultants will lay into the nurses over it. It's not the apprentices problem. They do as they like.

The domestics are leaving lists of jobs for the nurse to do so that the domestic can leave on time. The nurse is already staying over 2 hours past the end of her shift just to accomplish the things that only and nurse can do, and that is before you take into account all the things she is having to pick up because the apprentices do nothing.

The clinical techs are bullying the doctors. Clinical techs are people who are hired and trained to draw blood and insert cannulas. They have no further education or registration. You do not need any kind of schooling or anything to do this job. The clinical techs often worked at tescos prior to being clinical techs. They just do venflons and bloods to take the load off the docs a bit. Here is another group of people who have no real responsibility or consequences because they are not professionals, dumping on already overstretched professionals with no personal consequences to themselves. The problem is, they are sat in the cafe telling the doctors to do their own cannulas. They tell the junior doctor who is running between multiple wards with all that life and death responsibility off for asking them to do a venflon.

The clinical tech's favourite line is "Tell the doctor I am to busy, so he has to draw the labs himself". OMG you fucking slacker do you have any idea about what the doc has on his shoulders? He has a list of jobs on mulitple wards. IF he is telling you that he cannot take the time to draw blood, THEN HE REALLY CANNOT FUCKING TAKE THE TIME TO DRAW BLOOD.

The clinical techs are either answering pages to do venflons or they are kicking it in the cafe upstairs. If they are asked to come and insert a cannula they want to know why the junior doc is being to "lazy" to do it himself. Hey, if it doesn't get done it's the doctor's and nurse's ass isn't it? The unregistered staff never has to suffer any consequences. They don't. They just keep on passing the buck which stops with the few of us who can be held accountable for our actions or omissions.

Recently I saw a clinical tech screaming at a junior doctor for paging her to draw some blood. The clinical tech was annoyed because the doctor was already on the ward that required the blood draw. She didn't see why the doc couldn't just do it herself. The stupid little shit doesn't want to realise that the doctors have patients all over the fucking place and they they need to do what they can for the patients they are with, delegate anything that they can, and then run off so that they can get to the next patients.

The housekeeper takes 20 minutes worth of break time every hour and follows the 2 nurses around reminding them to clean the toilets properly. "Remember you have to fill in the cleaning forms, they are so important because management says they are". Then she castigates the nurses as lazy. Thick as pigshit she is.

If a doctor points out that an alcohol handgel cannister is empty to the housekeeper, she turns around and points to the storage cupboard where the re-fills are kept. Which means that it gets left empty because doctors are running their asses off trying to keep patients alive and really shouldn't be re-filling stock.

I had a domestic order me (when I was in the middle of a 2 hour late long and complicated drug round from hell) to empty the waste bins and collect in the dinner plates for her so she could leave on time. I was already slated to be there 2 hours at least past the end of my shift just doing nursing stuff. And that is before you take into account that my patients were sitting in pee soaked chairs for the last 8 hours because the apprentices, the only help I have, are refusing to lift the patients. Out of everything that is going on, it is one of the only things the apprentices could do to help out.

When we try and tell these people that the nurses and doctors are already overwhelmed and patient's are suffering we are told "Well, everyone is stressed". Really. And how the fuck are you people stressed when you are doing nothing and don't have any accountability to the law or a professional body? Serioulsy. If a care assistant or an apprentice causes harm to a patient the RN responsible for that patient takes the fall. They are working on my license.

Pretty soon the domestics are going to be bleeping the doctors to empty the rubbish bins, so that the domestics can have their breaks. Staff nurses rarely get breaks, and doctors never get them. I am waiting for the apprentices to start asking the doctors to empty the catheters for them. They are already refusing to assist the nurse's with anything. "You are the nurse, do it yourself, don't dump your job on me, it's time for my tea break". So the patient gets left sitting in pee for another hour until I can finish getting the guy with chest pain sorted out.
What happens when we try and knock these people into line? They get all upset and cry that they are being bullied. And management does not want the professionals pissing off the easily controllable and cheap labour. We are told that they are "stressed too" and that we should help them more. Yeah it must be stressful spending the day on your mobile and going out for fag breaks.

That looks harsh doesn't it. I did not make that list because I am some snob who thinks I am better. I may quite happily hand in my registration and proudly start working as an HCA or a tech again. I made that list because if the shit hits the fan with patients, it is the doctors who have the most to lose. The nurse comes in second with the most to lose. That is why we delegate. It isn't because we are lazy or snobby. Now show some fucking respect and give us a hand.

30 comments:

Just to endorse, for those readers who might doubt the veracity of what Militant Medical Nurse writes here or think it might be an exaggeration, that she is telling it like it is. It's a good example of the way current politico-economic values result at the coal face in the corrosion of the morale and spirit of the more altruistic; and so says it all about those values.

I watched my ward sister state she was taking responsibility for fact that the NA had given the patient lunch just before her scope that we had waited a week to get booked .... Why did she say that? We all know it's not her fault. We had said for two days running she was not to have lunch, said it to the same NA in the morning. We weren't even telling the NA off as we were too astonished she had forgotten (and too depressed to tell anyone off!) Another hospital doctor

The NA's do sit in on report but I am 100% sure that they sleep their way through it.

If it says in handover that we need a urine sample from the patient in bed 12, the NA will sure as shit throw that urine away as soon as she removes the commode.

If it says in handover that we need to do obs on the patient in bed 8 every hour. You have to do it yourself, or remind the NA every hour.

It's the nurse who gets it in the neck from a consultant not the NA.

As an RN with 15-30 patients there is no way I can do all the vitals, fluid balances, and weights by myself while carrying all the meds and orders, ward rounds and fire fighting myself.

I had a consultant throw a chart at me the other day and he said this" These fluid balance charts are so sloppy, you nurses are pathetic". But if I said "The 16 year old nursing assistant did it" then it just looks like I am shifting responsibility

Anne, That's why I left the floor. I had a few wonderful aides on the floor I used to work. But most of the unlicensed personnel were just the pits! And I was ultimately responsible for them! The last straw was when I finally wrote an aide up for lying to me about taking vital signs (she didn't, and left without doing them!) and my nurse manager gave her a freaking pep talk and then tore my report up! It really let me know how much management respected me as a professional. AND several of the crappy aides (not the good ones) banded together after that to make my life as hellish as possible. But I didn't care by that time. I was outta there, and just told them, "Keep it up and I'll write you all up for insubordination! And the write-ups will go over our manager's head! I dare ya! Cause I am itching to clean house before I leave here!" After that, I got left alone and even got a phone call at home from my manager about what could be done to keep the nurses from running out the door. In a nutshell, I said that the hospital had lost sight of the value of their licensed personnel. If they really wanted to keep them, they'd better start demanding that other personnel give them the respect they deserve! I don't really know what got done.Casey in the USA

Just wondering, having read in the nursing standard that the rcn and the nmc have now shwon an interest in the registration of healthcare assistants, what do you rhink of this? Do you think they would take their jobs more seriously if they could loose the right to work if they dropped a bollock? I know it inst that simple and there would have to be nationally recognised standards of training but could it be a step in the right direction?

Those of us who remember what an EN (enrolled nurse) used to do/be realise that what the powers that be are planning to do is turn HCAs into EN-lite. Our Trust has a role called an AP which is a band 3 HCA that has done a woefully inadequate piece of training that supposedly means that they can pretend to be nurses. I refuse to have them in the ICU and have been called "elitist" by the school of nursing and hospital management. I'm sticking to my guns on this one...ICUs need RNs- end of. We all know where this is heading. The NHS is on its knees and I give it 10 years before it implodes. The private sector will take over. The rich will get RNs to look after them and the rest of us will get no-one.

We have ap's at my trust, I've worked with one. They get band 4. I have no idea what training they have completed, but I have heard rumours that they will be creating more and they have to have done a foundation degree at the local uni that provides most of the cpd for qualified staff.

I left nursing even though I loved looking after patients. This fish has slipped through the NHS net. There is no way I could be tempted back. I checked the fluid balance charts completed by various support staff. A cup of tea was written up as 50ml and as 60ml and as 80ml! I spoke to the support staff concerned and got a load of lip in return. There was no respect. Management didn't care. If, heaven forbid, I am ever admitted as a patient myself I will make damn sure that I do my own personal fluid balance chart and show it to the doctors because I had no confidence whatsoever that these charts were accurate. I would advise you all to do the same.

I think that in some cases, nurses do have the fault, maybe they are thinking on that cute doctor or on that cute patient, but in other cases nurses are just nervous, it is their first time, maybe the doctor is rude or like ways on a certain way.

It is an issue which we have to devote our time and attention to understand and learn more about this, actually I am in total agreement with what is written here and now I can only say good job and continue doing its work.

Respect? What respect? Here are some examples of responses from NHS healthcare assistants, when they were instructed to carry out a task:- "Do it yourself". "Why - can't you do it?" (in an impertinent tone of voice) "I'm too busy right now", (no they weren't). "It's time for my break" (no it wasn't). "You do what you're asking me to do and I'll do the job you're doing". (No you damn well won't, it isn't multiple choice!) When instructed to leave a patient alone, HCA completely ignored the instruction and went ahead and disturbed the patient anyway. And in an accusing tone of voice - "you've been ages, haven't you finished that yet? Ooh,you should have done that by now". (No not supervisor to HCA - HCA chancing her arm and being cheeky to person supervising her!!!) When told to complete charts properly - "well it is YOUR responsibility" (of course it is you stupid kid, that is the reason I am telling you to be careful). What is going on? The answer is simple - they do it because they have discovered that they can get away with it. There is no fear because there is no discipline from above. Can you imagine what would happen to an army Private who, when given an order by his Sergeant, said "do it yourself". Exactly.

In an atmosphere if universal deceit telling the truth is a revolutionary act. George Orwell.

Why has Nursing Care Deteriorated

Good nurses are failing every day to provide their patients with a decent standard of care. You want to know what has happened? Read this book and understand that similiar things have happened in the UK. Similiar causes, similiar consequences. And remember this. The failings in care have nothing to do with educated nurses or nurses who don't care. We need more well educated nurses on the wards rather than intentional short staffing by management.

About Me

I am a university educated registered nurse. We had a hell of a lot of hands on practice as well as our academic courses. The only people who say that you don't need a brain or an education to be an RN are the people who do not have any direct experience of nursing in acute care on today's wards. I have yet to meet a nurse who thinks that she is above providing basic care. I work with nurses who are completely unable to provide basic care due to ward conditions.
I have lived and worked in 3 countries and have seen more similarities than differences. I have been a qualified nurse for nearly 15 years. I never used to use foul language until working on the wards got to me. It's a mess everywhere, not just the NHS.
Hospital management is slashing the numbers of staff on the ward whilst filling us up with more patients than we can handle... patients who are increasingly frail. After an 8-14 hour shift without stopping once we have still barely scratched the surface of being able to do what we need to do for our patients.

Quotes of Interest. Education of Nurses.

Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."...Journal of advanced nursing 2007

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania identified a clear link between higher levels of nursing education and better patient outcomes. This extensive study found that surgical patients have a "substantial survival advantage" if treated in hospitals with higher proportions of nurses educated at the baccalaureate or higher degree level.

THIS MEANS WE NEED WELL EDUCATED NURSES AT THE BEDSIDE NOT IN ADVANCED ROLES

Dr. Linda Aiken and her colleagues at the University of Pennsylvania's Center for Health Outcomes and Policy Research found that patients experienced significantly lower mortality and failure to rescue rates in hospitals where more highly educated nurses are providing direct patient care.

Evidence shows that nursing education level is a factor in patient safety and quality of care. As cited in the report When Care Becomes a Burden released by the Milbank Memorial Fund in 2001, two separate studies conducted in 1996 - one by the state of New York and one by the state of Texas - clearly show that significantly higher levels of medication errors and procedural violations are committed by nurses prepared at the associate degree and diploma levels as compared with the baccalaureate level.

Registered Nurse Staffing Ratios

International Council of Nurses Fact Sheet:

In a given unit the optimal workload for a registered nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission.

A workload of 8 patients versus 4 was associated with a 31% increase in mortality. (In the NHS RN's each have anywhere from 10-35 patients per RN. It doesn't need to be this way..Anne)

Registered Nurses in NHS hospitals usually have between 10 and 30+ patients each on general wards.

Earlier in the year, the New England Journal of Medicine published results from another study of similar genre reported by a different group of nurse researchers. In that paper, Needleman et al3 examined whether different levels of nurse staffing are related to a patient’s risk of developing complications or of dying. Data from more than 5 million medical patient discharges and more than 1.1 million surgical patient discharges from 799 hospitals in 11 different states revealed that patients receiving more care from RNs (compared to licensed practical nurses and nurses’ aides) and those receiving the most hours of care per day from RNs experienced fewer complications and lower mortality rates than those who received more of their care from licensed practical nurses and/or aides. Specifically for medical patients, those who received more hours per day of care from an RN and/or those who had a greater proportions of their care provided by RNs experienced statistically significant shorter length of stay and lower complication rates (urinary tract infections, gastrointestinal bleeding, pneumonia, cardiac arrest, or shock), as well as fewer deaths from these and other (sepsis, deep vein thrombosis) complications

•Lower levels of hospital registered nurse staffing are associated with more adverse outcomes such as Pneumonia, pressure sores and death.
•Patients have higher acuity, yet the skill levels of the nursing staff have declined as hospitals replace RN's with untrained carers.
•Higher acuity patients and the added responsibilities that come with them increase the registered nurse workload.
•Avoidable adverse outcomes such as pneumonia can raise treatment costs by up to $28,000.
•Hiring more RNs does not decrease profits. (Hospital bosses don't understand this. They think that they will save money by shedding real nurses in favour of carers and assistants. The damage done to the patients as a result of this costs more moneyi.e expensive deaths, complications,and lawsuits, and complaints....Anne)

Disclaimer

I know I swear too much. I am truly very sorry if you are offended. Please do not visit my blog if foul language upsets you. I want to help people. That is why I started this blog and that is why I became a Nurse. I won't run away from Nursing just yet. I want to stick around and make things better. I don't want the nurses caring for me when I am sick working in the same conditions that I am. Of course this is all just a figmant of my imagination anyway and I am not even in this reality. Or am I?Any opinions expressed in my posts are mine and mine alone and do not represent the viewpoint of the NHS, the RCN, God, or anyone else.